If you’re considering braces but aren’t sure if Medicaid covers them, you’re not alone. Many people wonder whether Medicaid will pay for braces, especially when it comes to children and adults.
In this article, we’ll explore what Medicaid covers when it comes to orthodontic treatment and what you need to know to determine if you’re eligible for coverage.
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Does Medicaid Cover Braces?
Maybe! Medicaid coverage for braces varies by state and depends on your specific needs. In general, Medicaid will typically cover braces if they’re deemed medically necessary.
This means that your teeth must have a severe misalignment that affects your speech, chewing, or overall oral health.
Here are some things that might qualify your braces as medically necessary:
- Severe overbite or underbite
- Severe crowding of teeth
- Difficulty chewing or speaking due to misalignment
However, Medicaid usually won’t cover braces for purely cosmetic reasons.
How to get free braces with Medicaid?
To qualify for free braces under Medicaid, your condition must be classified as medically necessary. This typically includes severe dental issues such as:
- Misaligned jaws that cause difficulty eating or speaking.
- Severe overbites or underbites.
- Dental deformities that impact overall health.
If you suspect your condition might qualify, the first step is to consult an orthodontist who accepts Medicaid. They can evaluate your case and submit the necessary documentation to Medicaid for approval.
What is considered medically necessary braces?
Medically necessary braces are those required to correct serious dental or orthodontic problems that affect your health. Cosmetic issues, such as slightly crooked teeth, are generally not covered.
Examples of medically necessary conditions include:
- Extreme crowding of teeth.
- Congenital abnormalities like cleft palate.
- Issues that lead to chronic pain or discomfort.
Your orthodontist will need to provide a detailed report, including X-rays and photographs, to demonstrate the necessity of the treatment.
Will Medicaid Pay for Braces for Adults?
Medicaid’s coverage for adult braces is much more limited compared to children. Most states only provide orthodontic coverage for adults if the braces are deemed medically necessary.
For example, if braces are required to prepare for a surgical procedure or to correct a severe dental condition, Medicaid may approve the treatment.
How to get free braces
While Medicaid may not always cover braces, there are still ways to make orthodontic treatment affordable.
Affordable options
- Payment Plans: At Somos Dental, we offer flexible payment plans to make braces accessible without the need for insurance.
- Community Programs: Some nonprofit organizations provide free or low-cost braces for eligible individuals.
- Dental Schools: Many dental schools offer orthodontic treatment at reduced rates as part of their training programs.
In our clinic in Laveen, we always advise our patients to explore these options if Medicaid coverage isn’t available. This ensures that everyone has access to the care they need without undue financial stress.
Orthodontic insurance for adults
Orthodontic insurance for adults can help make braces more affordable. Many dental insurance plans, like Delta Dental, Cigna, and Humana, offer coverage for orthodontic treatments, including braces.
However, coverage often varies, with some plans offering partial coverage or lifetime maximums. It’s important to review the details of your plan, including waiting periods and provider networks, to ensure you get the best value for your treatment.
Things to consider
- Lifetime Maximum Coverage: Most plans have a limit on how much they’ll pay for orthodontics.
- Waiting Periods: Some plans require a waiting period before orthodontic benefits kick in.
- Network Providers: Choose a plan with a broad network to maximize savings.
- Additional Benefits: Look for plans that include coverage for routine dental care alongside orthodontics.
Finding Quality Dental Care Without Insurance
Even if Medicaid doesn’t cover your braces, there are still options! Many dental clinics, including Somos Dental, offer affordable payment plans and discounts to make braces more accessible.
Find us in Phoenix and Dallas for affordable dental care:
Phoenix:
Feel free to call us at 623-869-1091 or complete our online form to book your FREE CONSULTATION. You can also reach us via Messenger, SMS, or WhatsApp.
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